Yes, there are special Medicare Advantage Plans. Lets look at two:
Chronic Special Needs Plans &
DUAL Medicare / Medicaid Plans
Chronic Special Needs
Diabetes | Congestive Heart Failure | Cardiovascular Issues
Welcome to Chronic Special Needs from AdvantageAdvantage.com. This section of our website is specifically designed for people who have Medicare and a Chronic Medical Condition such as Diabetes, Congestive Heart Failure or Cardiovascular problems.
If you already have Medicare and a chronic condition, please give me a call and we can discuss your options. I only work with plans that have been approved by Medicare so you can be assured that they are designed with your best interests in mind.
CLICK HERE for my Chronic Special Needs Section.
Dual Special Needs
|Dual Special Needs Plans||The Difference Between |
Medicare and Medicaid
|Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage Plans for people who are entitled to both Medicare and Medicaid. Medicare is a Federal Government program and Medicaid is managed by individual States.||The difference between Medicaid and Medicare is simple. Medicare is managed by the federal government and is mainly based on age. Medicaid is managed by states and is based on income. There are special circumstances, like certain disabilities, that may allow younger people to get Medicare.|
|What is Healthy Connections?||Who Pays What?|
|Not all States call their programs Medicaid. For example, Healthy Connections is South Carolina’s Medicaid program.||Medicare pays covered dually eligible beneficiaries’ medical services first, because Medicaid is generally the payer of last resort. Medicaid may cover medical costs that Medicare does not cover or only partially covers.|
|Medicare & Medicaid Terminology||Lets Talk About the Extra Benefits|
|You may hear some funny sounding terms when discussing Dual Medicare and Medicaid programs. One such term is:|
Qualified Medicare Beneficiaries (QMB)
This program may help pay your Medicare Part “B” Premiums. In South Carolina, it is Healthy Connections that makes QMB determination.
|Dual plans go beyond either Original Medicare or Medicaid alone. You still get to keep the Medicaid benefits and have additional benefits. The DUAL plan that I have in mind for you will get you many extra benefits and features than Original Medicare at no extra cost.|
Dual Eligible (DE): encompasses all Medicare beneficiaries who receive Medicaid assistance, including those who receive the full range of Medicaid benefits, those who receive assistance only with Medicare premiums (A and/or B) and those who the state protects from cost sharing. The categories include QMB, QMB+, SLMB, SLMB+, QI, QDWI and FBDE (Medicaid Only).
Full Dual Eligible: Full Duals receive assistance from Medicaid with Medicare Premiums and/or cost sharing and also qualify to receive Medicaid benefits that are covered by Medicaid that are not covered by Medicare (typically includes unlimited routine transportation, dentures, eyeglasses, hearing aids, Long Term Care benefits, etc.). Full Dual categories include QMB+, SLMB+ and FBDE.
Partial Dual Eligible: Partial Duals are beneficiaries with somewhat higher income and asset levels who are not eligible for full Medicaid, but are eligible for more limited Medicaid coverage. These beneficiaries qualify for assistance with Medicare premiums and (for QMB) cost sharing. Partial dual categories include QMB, SLMB, QI and QDWI.
Medicaid Only (FBDE): (Non‐QMBs): Individuals entitled to Medicare and eligible for full Medicaid benefits (typically, categorically, or through optional coverage groups such as medically needy or special income levels for institutionalized or home and community‐based waivers) but not as a QMB (do not meet the income or resource criteria for QMB or SLMB). Payment of Medicare Part B premiums is optional. States provide Full Medicaid Benefits and in some states cover Medicare Cost Sharing. These may be listed in contracts as Medicaid/Medicare or FBDE (Full Benefit Dual Eligible).
Qualified Medicare Beneficiary (QMB): Entitled to Medicare Part A with income not exceeding 100% of the Federal poverty level, and resources not exceeding twice the SSI limit. Eligibility for Medicaid is limited to payment of Medicare Part A and Part B premiums and Medicare deductibles and coinsurance for Medicare services provided by Medicare providers. Medicaid covers Part A
Premium, Part B Premium and Medicare Cost Sharing.
Qualified Medicare Beneficiary Plus (QMB Plus): Same as QMB and also eligible for full Medicaid benefits for Medicaid services provided by Medicaid providers. Medicaid covers Part A Premium, Part B Premium, Medicare Cost Sharing and Full Medicaid Benefits.
Specified Low‐income Medicare Beneficiary (SLMB): Entitled to Medicare Part A with income above 100% FPL but less than 120% FPL, and resources that do not exceed twice the SSI limit. Medicaid covers the Part B Premium Only.